Purpose: Pancreatic cancer is considered one of the deadliest cancers given its abysmal 5-year survival rate. Per the National Comprehensive Cancer Network (NCCN), two regimens FOLFIRINOX (combination fluorouracil, leucovorin, irinotecan, and oxaliplatin) and Gemcitabine plus Nab-paclitaxel (GnP) are listed as preferred without preference to one. The purpose of this article is to provide practitioners in oncology with the data regarding the optimal neoadjuvant treatment of borderline reseactable pancreatic cancer resulting in higher rates of resection and longer overall survival.
Method: a PubMed Search was performed using combinations of the terms “borderline resectable pancreatic cancer”, “FOLFIRINOX”, and “Gemcitabine and Abraxane”. Filters were added to the search limiting the articles to publication within the last 10 years and free full text available. A review of current NCCN pancreatic guidelines was performed. A review of UpToDate treatment recommendations for potentially resectable pancreatic cancer was also performed.
Results: From the search 50 papers were identified from the PubMed Search. Ultimately, 15 papers were utilized for this review.
Conclusion: FOLFIRINOX and GnP both are suitable neoadjuvant regimens with documented success in converting borderline resectable pancreatic patients. FOLFIRINOX, with increased toxicity, results in higher rates of resection and increased rates of overall survival. Further research and head to head data is needed, directly comparing the two regimens in a randomized clinical trial.
Gallo L. Optimal Neoadjuvant Treatment for Borderline Resectable Pancreatic Cancer. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2020; 2(2).
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